When I started my internal medicine residency, I was pretty sure I was going to rock this primary care thing. I knew the drugs for hypertension, the guidelines for diabetes management, and depression management seemed like nothing more than an algorithm. I felt buoyed by familiarity as I looked at the problem list for my first primary care patient: basically diabetes, hypertension, and depression. As I opened the exam room door that early July day, I ...

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The attitude when it comes to treating chronic pain Here is the attitude of ER physicians: "Here are a few pills to hold you out for one or two days. Follow up with your PCP -- he or she should be managing your chronic pain -- not me. Now get out of my ER!" Here is the attitude of PCPs: "I simply don't have the time or expertise to manage chronic ...

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A letter to Dr. Oz for his inbox Dear Dr. Oz, I know the #OzsInBox question on Twitter didn’t exactly go the way you or your social media team expected.You told Sen. McCaskill when she asked you about the so-called miracles and medically baseless products that you promote on your show that you view yourself as a cheerleader, but consider #OzsInBox a wake-up call that doctors (or at ...

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The term "Golden Age" seemed to permeate multiple domains in the 1950s, almost to the point of triteness. The field of cardiac surgery, however, deservedly earned the term as pioneer after pioneer introduced innovation after innovation that advanced the specialty. Walter Lillehei in Minnesotta, Wilfred Gordon Bigelow in Toronto, William Chardack in Buffalo, and Ake Senning in Stockholm were just some of the trailblazers of that era. The four surgeons also shared ...

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Human life is a gift.  Death, too, can be a gift.  Is it ever appropriate for us to choose the timing of our death? Brittany Maynard, 29, was diagnosed with a stage 4 glioblastoma, an aggressive and uniformly fatal brain tumor.  With the blessing of her family and millions of supporters around the world, she ended her life in Portland, Oregon, with a fatal dose of barbiturates prescribed by a physician.  ...

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What we are trying to do is create a system that gets rid of the human factor. - an internal medicine physician I heard this statement in a patient safety seminar designed for medical residents. I paused, shuddered even, as a resident who writes poems and reads novels in my free time. To my surprise no else blinked an eye. And why should they? The concept that physicians’ humanity and empathy shape health ...

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We owe it to our patients to put on our game faces When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?” When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?” When you steel yourself ...

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I’m getting to the point where I think it might be time to stop or at least decelerate the pace of my writing on medicine. When I retired from medical practice almost a year ago there were a lot of pent up experiences that I felt a need write about. But now I have already written about almost everything that I wanted to and, as I am no longer a practicing physician, ...

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What does a good death mean to you? In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor. At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. ...

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The publics lack of trust in science is alarming Cynicism appears to have replaced idealism as America’s defining characteristic.  So many of us just don’t trust the government, scientists, the clergy, journalists, business CEOs, labor unions, lawyers, or just about anyone for that matter, to say or do the right thing. Two years ago, the National Journal reported that as a consequence of the Great Recession, “Americans are losing faith in ...

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